SHOULDER2

Chronic Shoulder Injuries

Adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain. Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes. It can be idiopathic or due to traumas of the joint and surgeries, particularly if treated with a prolonged immobilisation. It is characterised by a progressive loss in the range of movement as the joint capsule loses flexibility. The injury affects more frequently women between 40 and 60 years old .
You will be prescribed X-rays to identify the presence of calcifications or further pathologies.
The process of recovery is usually quite slow and may require more than 2 years. It consists in activities in the gym, and at home and attention given to the recovery of the range of motion.
Physical modalities , acupuncture and medicines can be of help.

Shoulder impingement syndrome is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. This can result in pain, weakness and loss of movement at the shoulder.Every time the upper arm is lifted overhead, a narrowing of the space between the humeral head and acromion occurs. This space, (the subacromial space) is where tendons of the rotator cuff are located, protected by the bursa. Performing sports, or everyday activities which require repetitive overhead movements, rotator cuff muscle imbalances, or irregularities in the acromion profile may all cause increased friction inside this space, which can lead to the formation of calcium deposits within the subacromial space. Pain usually occurs at night. This series of events inevitably causes disuse of the arm, causing the arising of intra-articular adherences and a worsening of the condition. Quick and correct diagnosis followed by an early start to rehabilitation is key here, as stopping the vicious cyrcle mentioned above ensures rehabilitation is faster and more effective. Adopting this approach negates the need for prolonged courses of anti-inflammatory drugs, as well as preventing secondary damage to the joint through the adoption of bad postures. In case investigations show the presence of relevant anatomic alterations, such as almost complete tear of tendons of the rotators cuff or the localisation of large calcific deposits, surgery may be required together with a following rehabilitation.

When talking about unstable shoulder, different diagnosess are to be taken into consideration, such as dislocations, subdislocations . Various classifications have been proposed, but we will refer to that instability that involves patients with signs of congenital generalised laxity, associated with bilateral and multidirectional (anterior, posterior and inferior) instability of the shoulder. The instability can also affect sportspeople such as gymnasts, volleyball players, weightlifters and swimmers. The traumatic mechanism is to be found in the repetition of overhead movements that, due to the joint laxity, provoke a mechanic stimulus on the nervous structures and periarticular soft tissues (repeated microtraumas) that lead to pain. If you entered this section, it means that you probably are starting feeling pain in your shoulder or that you are suffering from disturbances such as “dead arm” or paresthesia of the superior limb when performing daily or sportive activities. You might also have faced different times a dislocation or subdislocation without a meaningful trauma. The physichian will prescribe for you further examinations to detect which are the conditions of capsular, tendinous, and muscular structures. The conservative treatment represents the first approach to the management of this complex clinic situation. The work is mainly finalised to improving the joint biomechanics though exercises for those muscles that stabilise the articulation. In particular, in the overhead sports it is necessary to reinforce all the cuff’s muscles, since they are involved in the control of the humeral translation. The recovery of the neuromuscular control is essential, as the deficit in co-ordination for these patients is typical. Co-ordination exercises can find a proper space in rehabilitation where the patient will undergo dynamic and more specific exercises. After the failure of at least 6 month of conservative therapy, a surgical intervention will be necessary and an appropriate rehabilitative treatment will follow.

The term “thoracic outlet syndrome” involves a series of usually bilateral symptoms determined by the compression of nervous and/or vascular structures . This compression may be due, however, to the alteration of the postural equilibrium of the scapula as well as by the prolonged activity of the arm in performing overhead activities. Provoking a reflex contracture of the scalene muscles. This phenomenon is more common in women between 20 and 50 years old, in sportsmen involved in body building with over the number ribs and hypertrophy of the scapula and in patients involved in water polo. This syndrome may cause throughout time chronic headaches, strength and co-ordination deficits of the arm, impossibility to perform working activities involving overhead gestures (painter, storekeeper…), or the Raynaud phenomenon that can lead also to the appearance of cutaneous ulcers on the arm or hand. To diagnose the syndrome properly, the physician will prescribe you different clinical examinations, starting from the radiography, passing through the three-dimensional CT scan. The suggested treatment is the conservative one and it tends to correct the postural behaviours such as the shoulder’s fall, the excessive retroposition of the shoulder and wrong behaviours performed in the ordinary life (bearing heavy objects, prolonged overhead gestures, sleeping on the painful side or with a limb in hyper-abduction). In case the conservative treatment fails, it will be necessary to proceed with surgery.